When humans or animals sustain displaced fractures of their long bones, they often have to undergo reduction of the fracture followed by placement of a fiberglass or plaster cast. Casting often involves immobilization of the arm or leg for 6 weeks. The application of a cast is typically a four part process: 1) placement of the stockingette; 2) overwrapping the limb with a thin cotton under cast padding material that provides padding between the limb and the cast; 3) applying the casting material itself; and 4) placing a 3 point mold in the cast which will hold the fracture in a reduced position. During step 2 and step 3 there are numerous mistakes that can be made which will not only lead to a lost fracture reduction over time, but will also subject the patient to a skin injury from an over packed or under protected pressure point. For example, the casting material is typically provided as a roll of a strip of soft material that must be wrapped around the limb in successive applications as it dries and hardens due to exposure to the air. In the United States, acute casting of a long bone fracture is often performed by orthopedic surgeons, orthopedically trained Physicians assistants or Nurse practitioners. Cast technicians usually assist with placement of large casts or apply casts to bones that are partially healing and do not require reduction.
During the time that the casts are being worn, the patient has to keep the inside of the cast dry. Traditional casts trap water between skin and cast. In the case of plaster casts, they must keep the outside of the cast dry as well. For small children in the summer time this could mean missing out on water activities. For the adolescent athlete or adult, this often means choosing between aerobic exercise and a relatively dry, less smelly and itchy cast. Keeping casts dry, clean, and intact may be difficult in austere environments or in developing countries with limited medical care or shelter for patients between appointments. Cast removal requires a cast saw which is loud, tends to scare children, and can subject patients to skin injuries if it is not used properly.
Currently there are several remedies for each of these challenges, but there are no products which address all of these issues simultaneously. One product is a GORE-TEX® padding (aqua cast) which can be applied usually around week 3 post-injury when the original cast is changed out. This however, has the objective of keeping water away from the skin. It can sometimes lead to small amounts of trapped moisture that macerate the skin. Another product is the EXOS® fracture brace which is not intended for holding reduced fractures in place and is only available in the short arm format. This product is aimed at treatment of non-displaced fractures, or fractures that have partially healed. This product also requires an oven made by the company that makes EXOS® for the purpose of heating the device so that it can be molded to the patient after it has been tightened down.
The art lacks a device to provide patients and healthcare professionals with a solution that can be applied immediately after injury, with minimal expertise, that allows the patient to perform routine hygiene without removing the cast or splint, and allows for removal of the cast without the use of a saw.